Not all children have a bowel movement every day. For some children, it is normal to go every couple of days. This is not necessarily an indication that your child is constipated. So, how do you know if your child is constipated? It can, at times, be difficult to tell.
Symptoms of constipation can range from hard pellet-like stools to large voluminous bowel movements. Constipated children often have pain with bowel movements and have to strain to go. This causes some children to withhold bowel movements out of fear that it will hurt. Withholding in turn leads to more constipation and the viscous cycle begins. While some children withhold out of fear of pain, others withhold out of fear of using a public restroom, and still others withhold as an exertion of independence. Regardless of the initial reason for withholding, once it results in constipation bowel movements will hurt and this will reinforce for the behavior.
Treating constipation almost always includes dietary changes. Drinking more water and eating more fruits and vegetables is key. Prunes, prune juice and raisins are all foods that can help. Individually wrapped prunes are easy to throw in your child's lunchbox. Raisins can be added to morning cereal or an afternoon snack. Switching to breads and cereals that are high in fiber will also help. Increasing your child's fiber intake can at times be difficult if he is a picky eater. Although fiber supplements are rarely necessary in children, they can be helpful for children who are going through a particularly picky eating stage. You should talk with your child's doctor before adding any supplements to your child's diet. Avoiding foods that bind is also important. Limit such foods as bananas and rice, which can add to constipation.
It's always a good idea to have a morning routine for your child that includes uninterrupted time on the toilet so that they do not feel rushed. Since for some children warm foods or liquids help facilitate the urge to go, start the morning with a warm bowl of cereal with raisins and maybe even a small cup of chamomile tea. Then allow your child to sit on the potty for 5 minutes while they relax with a book or toy.
For children who have been constipated for quite some time stool softeners may be necessary. Although most medication for constipation can be purchased over-the-counter, it is best to speak with your pediatrician before starting any stool softeners, laxatives or enemas. If medication is needed, there are many options. There are stool softeners that can be given orally, such as Colase or Miralax. Miralax has the added benefit of being a tasteless, odorless powder that can easily be added to drinks, applesauce or pudding. For children who cannot take medicine by mouth there are glycerin suppositories that can be given rectally. In addition to a stool softener, some children may also need a stimulant such as Senokot. For the child who needs both types of medications, there is the combination product Senna-S, which combines a stool softener with a stimulant. If a child is extremely backed up and having abdominal pain he may require a pediatric fleets enema before beginning daily treatment with a stool softener. If medication is needed, your pediatrician may recommend continuing it for quite a while after the initial bout of constipation has been resolved in order to avoid having the problem recur. During this time period dietary and behavioral changes should be implemented so that when the medications are weaned the child continues to go regularly.